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VOLUME 27 , ISSUE 5 ( May, 2023 ) > List of Articles


Flexible Fiberoptic Bronchoscopy in Non-ventilated Children in Pediatric Intensive Care Unit: Utility, Interventions and Safety

Anil Sachdev, Anuj Khatri, Ganpat Jha, Dhiren Gupta, Suresh Gupta

Keywords : Airway assessment, Bronchoalveolar lavage, Diagnostic Procedure, Flexible bronchoscopy, Pediatric intensive care unit

Citation Information : Sachdev A, Khatri A, Jha G, Gupta D, Gupta S. Flexible Fiberoptic Bronchoscopy in Non-ventilated Children in Pediatric Intensive Care Unit: Utility, Interventions and Safety. Indian J Crit Care Med 2023; 27 (5):358-365.

DOI: 10.5005/jp-journals-10071-24449

License: CC BY-NC 4.0

Published Online: 29-04-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Objective: To study the utility of flexible fiberoptic bronchoscopy (FFB), and its effects on oxygenation and hemodynamics in children while on respiratory assist devices. Materials and methods: The data of non-ventilated patients who underwent FFB during their stay in the PICU from January 2012 to December 2019 was retrieved from medical, nurses, and bronchoscopy records. The study parameters, demography, diagnosis, indication, and findings of FFB and interventions done after FFB, were noted, and also the oxygenation and hemodynamic parameters before, during and 3 hours after FFB. Results: Data from the first FFB of 155 patients were analyzed retrospectively. About 54/155 (34.8%) children underwent FFB while on HFNC. About 75 (48.4%) patients were on conventional oxygen therapy (COT) before FFB. There were 51 (33%) patients who had received mechanical ventilation and were extubated successfully. The 98 (63.2%) children had primary respiratory diseases. Stridor and lung atelectasis were indications for FFB in 75 (48.4%) cases and the commonest bronchoscopic finding was retained secretions in the airways. Based on the FFB findings, 50 medical and 22 surgical interventions were done. The commonest medical and surgical interventions were changes in antibiotics (25/50) and tracheostomy (16/22) respectively. There was a significant fall in SpO2 and a rise in hemodynamic parameters during FFB. All these changes were reversed after the procedure with no consequences. Conclusion: Flexible fiberoptic bronchoscopy is a useful tool to diagnose and guide interventions in non-ventilated pediatric intensive care unit (PICU). There were significant but transient changes in oxygenation and hemodynamics with no serious consequences.

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  1. Wood RE, Sherman JM. Pediatric flexible bronchoscopy. Ann Otol Rhinol Laryngol 1980;89(5 pt 1):414–416. DOI: 10.1177/000348948008900506.
  2. Shirzadi R, Navaei S, Razavi-Khorasani N, Masiha F, Hossein SM, Mohamadi M et al. Indications and complications of flexible fiberoptic bronchoscopy in children: A 5-year experience at a Tertiary Care Hospital in Iran. Iran J Pediatr 2020;30(2):e92535. DOI: 10.5812/ijp.92535.
  3. Hamouda S, Oueslati A, Belhadj I, Khalsi F, Tinsa F, Boussetta K. Flexible bronchoscopy contribution in the approach of diagnosis and treatment of children's respiratory diseases: The experience of a unique pediatric unit in Tunisia. Afri Health Sci 2016;16(1):51–60. DOI:
  4. Midulla F, de Blic J, Barbato A, Bush A, Eber E, Kotecha S et al. Flexible endoscopy of paediatric airways. Eur Respir J 2003;22(4):698–708. DOI: 10.1183/09031936.02.00113202.
  5. Sovtic A, Grba T, Grahovac D, Minic P. Flexible bronchoscopy in evaluation of persistent wheezing in children—Experiences from National pediatric center. Medicina 2020;56(7):329. DOI: 10.3390/medicina56070329.
  6. Sachdev A, Chhawchharia R. Flexible fiberoptic bronchoscopy in pediatric practice. Indian Pediatri 2019;56(7):587–593. PMID: 31333214.
  7. Davidson MG, Coutts J, Bell G. Flexible bronchoscopy in pediatric intensive care. Pediatri Pulmonol 2008;43(12):1188–1192. DOI: 10.1002/ppul.20910.
  8. Peng YY, Soong WJ, Lee YS, Tsao PC, Yang CF, Jeng MJ. Flexible bronchoscopy as a valuable diagnostic and therapeutic tool in pediatric intensive care patients: A report on 5 years of experience. Pediatric Pulmonol 2011;46(10):1031–1037. DOI: 10.1002/ppul.21464.
  9. Sachdev A, Chhawchharia R, Gupta D, Gupta N. Flexible fiberoptic bronchoscopy directed interventions in neonatal intensive care unit. Indian Pediatri 2019;56(7):563–565. PMID: 31333210.
  10. Sachdev A, Chhawchharia R, Gupta D, Gupta N, Joshi R, Agarwal N. Flexible fiber-optic bronchoscopy-directed interventions in children with congenital heart diseases. Indian J Crit Care Med 2020;24(5):340–343. DOI: 10.5005/jp-journals-10071-23419.
  11. Sharluyan A, Osona B, Frontera G, Brandstrup KB, Figuerola J, Sanz-Ruiz I, et al. High flow nasal cannula versus standard low flow nasal oxygen during flexible bronchoscopy in children: A randomized controlled trial. Pediatric Pulmonology 2021;56(12):4001–4010. DOI: 10.1002/ppul.25655.
  12. Lindholm CE, Oilman B, Snyder JV, Millen EG, Grenvik A. Cardiorespiratory effects of flexible fiberoptic bronchoscopy in critically ill patients. Chest 1978;74(4):362–368. DOI:
  13. Lundgren R, Hiiggmask S, Reiz, S. Hemodynamic effects of flexible fiberoptic bronchoscopy performed under topical anesthesia. Chest 1982;82(30):285–299. DOI: 10.1378/chest.82.3.295.
  14. Koumbourlis AC. Flexible fibre-optic bronchoscopy in the intensive care unit. Priftis KN, Anthracopoulos MB, Eber E, Koumbourlis AC, Wood RE (Eds): Paediatric bronchoscopy. Basel: Karger. Prog Respir Res 2010;38:54–63. DOI:
  15. Sachdev A, Gupta N, Khatri A, Ganpat J, Menon GR. Utility and safety of flexible fiberoptic bronchoscopy in mechanically ventilated children in pediatric intensive care unit. Pediatric Pulmonology 2022;57(5):1310–1317. DOI: 10.1002/ppul.25863.
  16. Faro A, Wood RE, Schechter MS, Leong AB, Wittkugerl E, Abode K, et al. Official American Thoracic Society technical standards: Flexible airway endoscopy in children. Am J Respir Crit Care Med 2015;1066–1080. DOI: 10.1164/rccm.201503-0474ST.
  17. Sachdev A, Chugh K, Sethi M, Gupta D, Wattal C, Menon G. Diagnosis of ventilator-associated pneumonia in children in resource-limited setting: A comparative study of bronchoscopic and non-bronchoscopic methods. Pediatr Crit Care Med 2010;11(2):258–266. DOI: 10.1097/PCC.0b013e3181bc5b00.
  18. Manna SS, Durward A, Moganasundram S, Tibby SM, Murdoch IA. Retrospective evaluation of a paediatric intensivist-led flexible bronchoscopy service. Intensive Care Med 2006;32(12):2026–2033. DOI 10.1007/s00134-006-0351-y.
  19. Pediatric acute lung injury consensus conference group. Pediatric acute respiratory distress syndrome: Consensus recommendations from the pediatric acute lung injury consensus conference. Pediatr Crit Care Med 2015;16(5):428–439. DOI: 10.1097/PCC.0000000000000350.
  20. Nussbaum E. Pediatric fiberoptic bronchoscopy: Clinical experience with 2,836 bronchoscopies. Pediatr Crit Care Med 2002;3(2):171–176. DOI: 10.1097/00130478-200204000-00015.
  21. Wang R, Li HC, Li Xy, Tang X, Chu HW, Yuan X, et al. Modified high-flow nasal cannula oxygen therapy versus conventional oxygen therapy in patients undergoing bronchoscopy: A randomized clinical trial. BMC Pulmonary Medicine 2021;21(1):367. DOI:
  22. Pelaia C, Bruni A, Garofalo E, Rovida S, Arrighi E, Cammarota G, et al. Oxygenation strategies during flexible bronchoscopy: A review of the literature. Respir Res 2021;22(1):253. DOI:
  23. Saksitthichok B, Petnak T, So-ngern A, Boonsarngsuk V. A prospective randomized comparative study of high-flow nasal cannula oxygen and non-invasive ventilation in hypoxemic patients undergoing diagnostic flexible bronchoscopy. J Thorac Dis 2019;11(5):1929–1939. DOI: 10.21037/jtd.2019.05.02.
  24. Simon M, Braune S, Frings D, Wiontzek AK, Klose H, Kluge S. High-flow nasal cannula oxygen versus non-invasive ventilation in patients with acute hypoxaemic respiratory failure undergoing flexible bronchoscopy – A prospective randomised trial. Critical Care 2014;18(6):1–9. DOI: 10.1186/s13054-014-0712-9.
  25. Sinha A, Jayashree M, Singhi S. Aerosolized L epinephrine vs budesonide for post-extubation stridor: A randomized controlled trial. Indian Pediatr 2010;47(4):317–322. DOI: 10.1007/s13312-010-0060-z.
  26. Bar-Zohar D, Sivan Y. The yield of flexible fiberoptic bronchoscopy in pediatric intensive care patients. Chest 2004;126(4):1353–1359. DOI: 10.1378/chest.126.4.1353.
  27. Kabra SK, Lodha R, Ramesh P, Sarthi M. Fiberoptic bronchoscopy in children: An audit from a tertiary care center. Indian Pediatr 2008;45(11):917–919. PMID: 19029566.
  28. de Blic J, Marchac V, Scheinmann P. Complications of flexible bronchoscopy in children: Prospective study of 1,328 procedures. Eur Respir J 2002;20(5):1271–1276. DOI: 10.1183/09031936.02. 02072001.
  29. Montravers P, Gauzit R, Dombret MC, Blanchet F, Desrrwnts JM. Cardiopulmonary effects of bronchoalveolar lavage in critically ill patients. Chest 1993;104(5):1541–1547. DOI: 10.1378/chest.104.5.1541.
  30. Davies L, Mister R, Spence DPS, Calverley PMA, Earis JE, Pearson MG. Cardiovascular consequences of fibreoptic bronchoscopy. Eur Respir J 1997;10(3):695–698. PMID: 9073008.
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